Brian Cox: Updated action plan urgently needed on cancer

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We need some way of measuring our progress, writes Associate Professor Brian Cox, chairman of the New Zealand Cancer Control Trust that in 2003 co-published with the Ministry of Health the New Zealand Cancer Control Strategy.

In 2008 more than 20,000 New Zealanders were diagnosed with cancer and 8566 people died of it. Photo / Thinkstock
In 2008 more than 20,000 New Zealanders were diagnosed with cancer and 8566 people died of it. Photo / Thinkstock

If you had a family member with cancer, wouldn't you want to know we had used all the tools we have to reduce our cancer death rates?

Wouldn't you want to know that the $500 million a year New Zealand's public health system spends on diagnosing and treating cancer was being spent the right way?

And since your taxes are going to pay for another $100 million a year or so by 2021 on top of our current spending, don't you want to make sure we are spending all that money as effectively as we can?

There is a way to reduce our death rates from cancer that doesn't require any more money, and we could put it in place almost straight away.

We need to do better because our cancer death rates have been increasing much faster than in countries such as Australia, Canada, the US and the United Kingdom.

In the 1990s, a group of people who work with cancer were so concerned about our performance compared to similar countries that they got together at a workshop in Wellington to work out what they could do.

Cancer has so many causes and affects so many different organs that a large number of organisations are working on preventing and treating it.

So the idea they came up with was to get government, all the cancer NGOs and health professionals working together on a strategy and action plan identifying the best way to use the resources available to us.

The beauty of a strategy and action plan is that they make sure everyone is working towards the same priorities. They make people responsible for putting the pieces in place and hold them accountable for their performance. Then we can measure our progress.

Without measuring we are never going to know if we're making gains or not.

That cancer strategy and action plan prepared in 2003 is getting dated. Parts are still valid, but they need to be monitored and updated accordingly.

The last action plan made a priority out of prevention, earlier diagnosis and making sure everyone had access to the same quality of treatment.

For example, a target was set for radiation treatment so that no one would have to wait more than four weeks after seeing a specialist. As a result, patients are not being sent to Australia for treatment any more.

Another example was success in reducing smoking among Maori and pregnant women as well as patients in hospital and those visiting their GP.

Two of the most common killers in New Zealand are lung and bowel cancers, so a special focus went on them.

None of these changes would have become a focus without the strategy and the action plan it produced.

Today, the Minister of Health appoints an independent advisory body called Cancer Control New Zealand.

This group gives advice about the topic, but it's not the same as bringing together everyone who works in the sector to work out our top priorities and make sure we use our resources to achieve them.

No one produces report cards. There is no place you can go to find out what is being monitored.

If you can't keep an eye on how well we're doing, then you can't hold anyone accountable for performance or make changes to improve performance.

Here's an example: no one can tell how well we are doing at reducing cancer death rates unless we have information about how long cancer patients have to wait from when symptoms appear until they are treated.

The delay can occur because a patient waits before seeing a doctor after the first symptoms appear. There can be a delay after a patient sees a doctor before cancer is diagnosed. And there can be a delay between initial diagnosis and treatment.

Unless we measure those different types of delay, we can't work out which is the highest priority for improvement and move the resources we have to that need. Yet we can't even be sure which type of delay is being measured.

An updated plan is needed to make sure priorities for action are clearly stated and a focus is provided for everyone working to reduce the rate of cancer in New Zealand.

It's particularly important to target cancer inequalities. We know there is a disparity - cancer doesn't kill equally.

Even though cancer rates are the same for Maori and non-Maori, Maori cancer death rates are higher.

Doing well for Maori will mean doing well for our cancer performance overall.

Cancer kills more of us than anything else. In 2008 more than 20,000 New Zealanders were diagnosed with cancer and 8566 people died of it.

New Zealand needs an updated cancer control strategy and action plan.

At the moment the Ministry of Health develops a plan for itself and for DHBs, but this plan is narrow and no one else is involved in developing it. It makes no mention of cancer NGOs, who 10 years ago were spending about $40 million a year on cancer services and activities.

What we need is an independent, expert review team to review progress, with representation from many backgrounds and strong representation from Maori, Pasifika and consumers.

And then we can measure our progress, provide a report card and be more effective in bringing our cancer death rates down.

- NZ Herald

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